Infants and pre-school children

A young baby is unable to communicate to us what it is it wants and what its body needs, so it is up to us as adults to take on the responsibility of providing them with a healthy and balanced diet - which should stand them in good stead for the future.

Infants and preschool overview

Research has proven just how significant a child's early years are in terms of long-term health and well-being, with various studies highlighting the importance of a child's first few weeks for future growth and development. However, meeting the nutritional demands of a new baby can be challenging, exhausting and overwhelming at the best of times, especially without the correct guidance and advice.

Mixed and conflicting messages from both the media, family and friends all mean that new parents can be left feeling confused and concerned they are not doing the right thing, but always remember that every child is different and what may have worked for one may not work for another.

In this fact-sheet, you will find some general advice about the nutritional needs of infants and young children. If you require further advice and guidance, either book an appointment with your GP, or use our directory to contact a qualified nutritionist in your local area.

Breastfeeding

The Department of Health has recommended that where possible, new mothers breastfeed their babies exclusively for the first six months of life. Breast milk is an extremely rich source of nutrition for newborns, providing just the right nutrients in the correct quantities as well as being packed full of antibodies which will help to establish a baby's immune system.

Much research suggests that babies who are breastfed exclusively are less likely to experience upset stomachs and infections compared to those who are bottle-fed formula, and evidence also suggests breastfed babies stand a reduced chance of becoming obese or developing health concerns of which there is a family history.

Post-birth, for the first few days the breasts will produce a yellow thick and sticky substance known as colostrum. This milk is low in fat and rich in carbohydrates, protein and antibodies which make it ideal for newborn babies. The milk also has a laxative effect, helping babies to pass their first stools which assists the flushing out of excess bilirubin which helps to prevent jaundice.

Soon after giving birth the colostrum will begin to change into thinner, whiter milk, with mature breast-milk usually starting to come through on around the third or fourth day after birth.

Though there is no medical advice recommending that certain foods be avoided during breastfeeding, some mothers believe that strong foods such as garlic and acidic citrus fruits upset their babies and make them less likely to suckle. If you do have a hunch that this may be the case then contact your GP before eliminating any specific foods to ensure that you are not inadvertently omitting any important vitamins or minerals.

There is also evidence to suggest that alcohol can affect the smell of breast milk which can subsequently affect your baby's feeding, sleeping or digestion. To avoid this ensure you always remain within the recommended daily guidelines for alcohol.

Bottle feeding

Despite the benefits of breastfeeding it is certainly not for everyone and some mothers will opt to bottle-feed their babies formula milk for either medical (for example, breastfeeding is not recommended for those on certain medication) or personal reasons. Opting not to breastfeed will not mean you are missing an opportunity to bond with your child, nor are you being selfish. Good parenting is about love, guidance and respect, and throughout life, these factors will be what your children come to rely upon.

If you would like to give your child breast milk but feel uncomfortable doing so, remember there is the option of bottle feeding your baby expressed milk. Expressing is a way of taking milk from the breast without the baby suckling, and can be done by hand or with a manual or electric pump.

On the other hand, you may opt to feed your baby formula milk, the composition of which is considered a safe alternative to breast milk. The three main types of formula milk are as follows:

  • Whey-based milk Usually intended for babies from birth, whey-based formulas have a similar balance of ingredients to that of breast milk.
  • Casein-based milk – Casein is not as easy to digest as whey and therefore supposedly keeps your baby feeling fuller for longer. It can be given to babies from birth but is usually intended for slightly older babies with a growing appetite.
  • Soya formula – Some babies are intolerant to cow's milk formulas and in these cases, soya formula is used as a substitute.

Generally, it is recommended that parents feed their baby cow's milk-based formulas, but if you are unsure about which type of formula to choose then talk things over with your midwife or a health visitor as they will be able to provide you with information and advice that will help you to make an informed decision. 

It can be difficult to gauge how much milk your baby needs and wants, but general guidelines advise that from birth to six months your baby will require an average of between 2 and 2.5 ounces of formula per pound each day. Don't be too concerned if your baby does not stick to these guidelines or those that appear on packet formula, the best way to gauge if your baby is healthy is to keep an eye on their weight and progress.

Though every baby is different, it is thought that feeding in small amounts often work best as the stomach of a baby is only tiny. Feeding your baby large amounts won't mean that they will go longer between feeds and it may cause adverse effects such as sickness and weight gain.

Bottle-feeding tips:

  • Ensure you have the right equipment before your baby is born - Just buying one bottle won't be enough, buy a few so you can use and wash them interchangeably. Also, make sure you have sterilising equipment to help you keep your baby's bottles clean. During the first six months, it is important to sterilise equipment between every use as your baby is more vulnerable to infection and milk is a breeding ground for bacteria.
  • Follow their lead When bottle feeding pay attention to what your baby is doing. If they begin to squirm remove the bottle as they may have had enough or need to burp.
  • Follow instructions – Don't try to rush things and guess formula amounts because you've made up tonnes of bottles before. You need to ensure that the proportion of water to formula is correct so your baby obtains maximum nutritional value.
  • Keep some ready-to-feed formula as a backupFormula can also be bought ready-made in cartons which are great for when you are either on a trip or rushing out the door and don't have time to make up a bottle.
  • Make bottles when needed It may sound more time consuming than making up multiple bottles in the morning and putting them in the fridge but it is recommended you make a fresh bottle when it is needed and that you throw away any leftover milk.
  • Make sure you buy recognised infant formula In the UK it is illegal to sell anything for your baby that is not a recognised formula which fulfils government guidelines on nutritional content.
  • Temperature preference Some babies prefer warm milk and others will drink it from the fridge so be sure to pay attention to your baby's preference. Always check the temperature of the milk to ensure it is not to hot by shaking a few drops on to the back of your hand.

Possible breastfeeding or bottle feeding problems

Diarrhoea and vomiting It is normal for babies to regurgitate small amounts of milk at the end of their feed but anything else such as vomiting after or between feeds or blood in the vomit or diarrhoea is cause for concern and could result in dehydration or electrolyte imbalance. Alert your doctor to this immediately so that action can be taken. If your baby is dehydrated, they will need extra fluids and these can be given orally between feeds or after each watery stool. Continue feeding your baby as normal during this time and be careful to wash your hands regularly with soap and warm water to avoid spreading the infection. 

Poor weight gain – Weight gain will usually be monitored by your midwife or a health visitor (though do keep an eye out yourself), either of whom will advise you if they feel your baby's growth rate is cause for concern. There are many factors which may contribute to poor weight gain, from using the incorrect formula to breastfeeding technique. If there is a problem your midwife, health visitor or doctor will let you know the steps which should be taken to promote healthy growth.

Excessive weight gain – Excessive weight gain is quite rare in babies who breastfeed exclusively, yet while bottle-fed babies tend to grow more quickly, it is understood that some may end up being over-fed. Babies feed little and often so aim to pace your baby's feeds according to when they feel hungry. If you are concerned that your baby is gaining weight excessively, contact your health visitor.

Introducing solid foods

When your baby reaches six months you should be able to begin introducing solid food in addition to breastfeeding or formula milk. At this stage, babies should be able to sit up, turn their heads and make chewing motions.

When new food is introduced this should be done gradually and in small amounts, giving the digestive system ample time to adjust.

Try beginning with soft and mashed foods such as pureed apple, mashed banana, mashed potato or rice cereal mixed with breast milk or formula. Introduce anything new one at a time so that you can gauge your baby's reaction and if they won't eat something at first try them again with it later.

It is worth noting that a hungry baby may be less receptive to trying new foods, so it is sometimes best to feed them breast milk or formula as you usually would before getting them to try something new. Try to leave a couple of days before trying a different type of food and begin with very small quantities which can be built up over time.

Babies spitting out their food and pulling faces is not necessarily an indicator of dislike and is more a way of showing they are experiencing a new sensation and taste. If they refuse a certain food it may take a few more attempts before they decide if they like it or not.

At around 9 months your baby may be able to start picking up small pieces of food to feed themselves with. Alongside your normal feeding regime try giving them little chopped up pieces of soft foods to try such as banana, dry cereal, well-cooked pasta etc. Each time you introduce something new leave a gap of a few days so you can see if it causes an allergic reaction.

Teething

Teething is the term used to describe the process of milk teeth breaking through the gums, usually beginning at around six to nine months. Though every child will differ it can take up to two and a half years for a full set of teeth to come through and during this time a child may experience a variety of side effects which tend to cause discomfort and probably a few tears.

To reduce irritation try teething gel or powder massaged into the baby's gums or infant paracetamol or ibuprofen.

Pre-school children

When children are between the ages of one and five, good nutrition is essential for child development of strong bones, teeth, muscles and a generally healthy body.

From one upwards you can begin to start feeding your children what the rest of the family eats, that is, of course, providing the family are eating a variety of healthy foods. To begin you will have to cut the food, help with feeding and be there to provide general supervision and guidance. By the age of five, preferably earlier, your child should be able to competently manage their mealtimes independently.

As most parents will probably know all too well, young children are full to the brim with energy and so their need for nutrients is high. Try to incorporate a wide range of healthy foods into their diet including fresh fruit and vegetables, dairy, poultry, lean meats, fish, eggs and whole grains. Try and keep junk food to a minimum but feel free to give your children the occasional treat such as crisps or chocolate as forbidding them completely may make them seem more attractive.

Healthy eating for children

Key food groups

Try to make sure that your child is having the following every day to ensure they are receiving all of the essential nutrients needed for optimum growth and health.

Carbohydrates - Carbohydrates such as cereal, bread, rice and pasta are a good source of energy for active and growing children.

Fruit and vegetables The government has recommended that everyone, including children, should aim for five portions of fruit or veg per day. However, this can be difficult to achieve when you are trying to feed a fussy toddler. Try thinking outside the box and use fruit in puddings and smoothies, vegetables raw with a dip or made into soups or sauces.

Milk and dairy foods - Children need calcium in their diet for bone growth so you should attempt to incorporate some into your child’s diet. From the age of one, you no longer need to use formula milk and normal cow's milk is fine. If your child isn't particularly keen on drinking lots of milk then you can incorporate dairy in many other ways such as in yoghurts, sauces and on cereals.

Protein As an essential part of a child’s diet, protein is important for cell growth and survival among other things. Some form of meat, fish or other protein sources should be eaten once or twice a day. Many nutritionists recommend 2 servings of fish per week, one of which should be oily and any meat cooked should be tender to ensure chewing is not a problem. Good alternatives to meat and fish are eggs and pulses.

Fats - Young children, and especially those under the age of two, require concentrated energy that is provided by fat. As children get older they can have less fat in their diets, but healthy unsaturated fats remain important. These can be sourced from foods like oily fish, avocados, seeds and nuts. The 'bad' saturated fats that are found in cream, cheese and fatty meats, on the other hand, should be limited.

Key nutrients

Vitamin A Promotes growth, healthy skin and cell development and can be found in eggs, cheese and some vegetables. This can be taken in the form of a supplement.

Vitamin C - Required for the immune system and growth as well as helping the body to absorb iron. This vitamin can be found in citrus fruits and various vegetables and can be taken in the form of a supplement.

Calcium - This nutrient is necessary for the healthy development of strong bones and teeth. Calcium is commonly found in dairy products.

Iron Plays a role in many essential bodily processes including carrying oxygen in the blood. Iron can be found in meat, certain dairy foods, some green vegetables and whole grains.

Zinc - Is needed to help the body's hormones and enzymes to perform. Can be found in meat, fish, dairy, whole grains and nuts.

Fussy eating

Young children can be extremely outspoken and stubborn at times so unless you are extremely lucky, you are likely to experience some food refusal or fussy eating incidents throughout your child's pre-school years.

Children often have a habit of making themselves sick of a particular food, so if you happen to discover they love bananas then refrain from overfeeding your child with them as they are likely to become fed up and start refusing them. By the same token, it is not uncommon for children to refuse foods they have never even eaten before. If this does happen then remain calm and don't attempt to force feed. Simply remove the food and try to introduce it again in a few days. Much nutritional research into children's nutrition has revealed that new foods may have to be offered several times before some children will show interest.

Though there is no way of avoiding fussy eating, it may help to implement a structured eating plan as opposed to allowing your child to graze throughout the day. If fussy eating becomes a serious issue then visit your GP or consult a nutritionist for further advice.

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